Endometriosis and miscarriages

I am 41 years old married for three years with no children. I had a laporoscopy to treat Endometriosis and they managed to remove cysts in my ovaries. I had other cysts but they couldn't remove them all. My fallopian tubes are clear and my ovulation and cycles are regular. My husband's sperm test was also fine. A year after my laporoscopy I became pregnant naturally after taking Puregon to increase number of eggs. I started with a low Progestrone level and took Endometrin. After a few days the pregnancy ended. Two months later I became pregnant again, this time totally naturally without any hormones. The pregnany lasted until the 9th week with a heartbeat and HCG level of 129992 and high Progestorone level. AT the 9th week suddenly my Progestrone dropped from 127 to 84 and the embryo stopped growing, to our dismay.
What do you recommend that we do or check? Do we need to test for anything specific? Do I have a hormonal problem with Progestrone and is this causing miscarriage? We are considering doing IVF but are worried that the pregnancy may not last.

Appreciate your response.

[Elaine Brown, MD]

Hi!
I'm sorry that you have not had success with your pregnancies.  The most common cause of miscarriage (especially in women over 35) is a chromosomal abnormality of the fetus.  This occurs because the ova (eggs) are as old as the mother, and over time wear and tear takes a toll on the cell division mechanism--then as the and the cell divides, too many or too few chromosomes are included which causes abnormal development and eventually demise.
Because you were able to conceive twice, you might be a very good candidate for IVF.
There are some tests such as a cycle day 3 FSH, an antral follicle count ( ultrasound )
and Mullerian Hormone level which can predict your response to the medications which are used to stimulate the ovaries.
PGD is a (somewhat controversial) way to determine which embryos are normal and therefore, which to transfer to the mom. This can be combined with IVF.
This is a lot of information! I hope it is all clear and understandable.
I wish you good luck!
Dr B